Adults with Congenital Heart Disease
During the research year (usually the second year of fellowship), fellows attend the Adults with Congenital Heart Disease clinic every eight weeks over a twelve month period. Working with faculty from Pediatric Cardiology, this rotation provides a comprehensive exposure to the diagnosis, assessment and management of outpatient presentations of most forms of congenital heart disease commonly encountered in adults. Resources include textbooks: Perloff’s Congenital Heart Disease in Adults and Perloff’s “The Clinical Recognition of Congenital Heart Disease”.
The goals of this training are to perform and become familiar with non-invasive assessments of peripheral vascular disease utilizing Doppler ultrasound. Fellows will evaluate patients with the assistance of vascular laboratory technicians. Trainees will have a hands-on experience in assessing patients with vascular disease using various modalities outlined below. A full range of noninvasive tests is available in the Vascular Laboratory including tests for: Peripheral Arterial Disease (PAD) - Doppler arterial exams of the legs or arms (Physiologic testing), duplex ultrasound scan of the extremity arteries; Cerebrovascular Disease - Carotid artery duplex scan; Deep Venous Thrombosis (DVT) - venous duplex scan of the arms or legs and inferior vena cava (IVC) scan; Renal Artery Disease - Renal artery duplex scan and duplex scan of the renal veins; Aortic Aneurysms - aortic duplex scan, duplex scan of peripheral arteries for aneurysms.
Fellows will be required to attend one half-day per week sessions each week for the entire month of the stress/nuclear medicine rotation. These sessions will occur on a morning that does not interfere with continuity clinic. The same weekday morning session will be followed for the remainder of the month. Besides the allocated time in the vascular medicine laboratory, fellows are expected to learn skills in the diagnosis, assessment and management of peripheral vascular disease in the patient population seen in the UIHC cardiology and VAMC continuity clinics. Fellows will also receive didactic lectures in peripheral vascular disease at core curriculum conference and during the weekly divisional clinical conference
The goals of cardiac rehabilitation training are to understand the indication for rehabilitation, medical evaluation for rehabilitation, understand how to implement an exercise program, teach patient’s lifestyle modifications, and learn the organization of psychosocial support in the UIHC cardiac rehabilitation program CHAMPS unit. The population will include patients with myocardial infarctions, coronary artery disease, heart failure, peripheral arterial disease, angina, cardiomyopathy, coronary artery bypass grafting, and valve replacement.
Fellows rotating on the nuclear medicine service will be involved with the CHAMPS team and will be working with them in a multidisciplinary approach. Fellows will be involved in phase I and phase II cardiac rehab. For phase I, fellows will assess patients in the intensive care unit after an MI and initiate an exercise and nutritional program prior to the discharge. For phase II rehab, fellows will see patients in the CHAMPS unit and monitor them on stationary exercise equipment. Fellows will also receive didactic lectures on cardiac rehabilitation during the core curriculum lecture series.
Most of our fellows choose one to two elective rotations. These usually involve the UIHC Echocardiography Laboratory or UIHC Nuclear Cardiology rotation or a combination of the two rotations to augment their training skills to meet COCATS Level 2 training requirements in Nuclear Medicine or Echocardiography. Since we do not have a rotation in Cardiac CT and MRI, many fellows utilize the elective rotations for an advanced cardiac imaging month (which includes Echo, Nuclear, Cardiac CT and/or MRI). Fellows may also choose a rotation through cardiothoracic surgery. However, most fellows choose to acquire TEE skills in the intraoperative setting by accompanying the UIHC echo lab staff physician to perform TEE in the OR. This gives a brief exposure to the fellows to operative techniques especially with regard to valve replacement or valve repair. In addition, fellows on the cardiac catheterization rotation also attend the joint TCV- catheterization lab conference.
Cardiac MRI and Cardiac CT
The goals of the cardiology fellowship program trainee are to acquire Level 1 training in cardiac MRI and cardiac CT which focuses on basic understanding and familiarity with these newer cardiac imaging modalities. This is accomplished by reviewing the ACC-SAP in Cardiac MRI and CT and attending the core curriculum lecture series geared to cardiac CT and MRI. Cardiac MRI studies maybe reviewed at the workstation in Radiology or in the UIHC echocardiography laboratory. Cardiac CT studies maybe reviewed at the workstation in Radiology or the workstation installed in the Cardiology Division in the Cardiac Catheterization laboratory film review area. Fellows will be expected to participate in the performance and interpretation of cardiac CT studies during the VA outpatient and inpatient blocks and occasionally on the UIHC consult and echocardiography laboratory rotations. Fellows are encouraged to participate in the performance and interpretation of Cardiac MRI studies during their UIHC echocardiography laboratory rotation. Level 1 training in cardiac CT and MRI includes mentored interpretation of 50 cases.
Advanced training in CT and MRI are offered for fellows who select cardiac imaging as their major career focus. The fellowship will allocate 12 months’ fellow effort to this training, either as a component of the individual fellow’s academic/research block, or as an additional year of training following completion of 36 months in the Cardiovascular Diseases fellowship. Each fellow will assume graduated responsibility for completion of CT or MRI studies, including patient selection, image acquisition, image analysis, data reporting and consultation with the referring physician. In addition, each fellow who selects this career path will engage in at least one research project that is centered on advanced imaging. COCATS 3 certification at our institution requires demonstration of independence in all aspects of clinical CT or MRI and, in addition, requires at least one peer review publication.
Level Specific Goals and Objectives
Junior Fellows (first year fellows)
Senior Fellows (second year fellows and above)
These are all elective rotations for senior level fellows only